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Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women
Open accessAbstract
In iron-depleted women without anemia, oral iron supplements induce an increase in serum hepcidin (SHep) that persists for 24 hours, decreasing iron absorption from supplements given later on the same or next day. Consequently, iron absorption from supplements is highest if iron is given on alternate days. Whether this dosing schedule is also beneficial in women with iron-deficiency anemia (IDA) given high-dose iron supplements is uncertain. The primary objective of this study was to assess whether, in women with IDA, alternate-day administration of 100 and 200 mg iron increases iron absorption compared to consecutive-day iron administration. Secondary objectives were to correlate iron absorption with SHep and iron status parameters. We performed a cross-over iron absorption study in women with IDA (n=19; median hemoglobin 11.5 mg/dL; mean serum ferritin 10 mg/L) who received either 100 or 200 mg iron as ferrous sulfate given at 8 AM on days 2, 3 and 5 labeled with stable iron isotopes 57Fe, 58Fe and 54Fe; after a 16-day incorporation period, the other labeled dose was given at 8 AM on days 23, 24 and 26 (days 2, 3 and 5 of the second period). Iron absorption on days 2 and 3 (consecutive) and day 5 (alternate) was assessed by measuring erythrocyte isotope incorporation. For both doses, SHep was higher on day 3 than on day 2 (P
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“They found that dosing 48 h apart enhanced iron absorption compared to three daily doses as it allows sufficient time for hepcidin levels to decrease and remove the mucosal block on absorption [34,35].”
From Oral Iron Supplementation—Gastrointestinal Side Effects and the Impact on the Gut Microbiota (2021) · cites this paper as [34]
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“Other groups have also confirmed enhanced iron absorption with single dosing once daily or alternate day dosing [33,34,36].”
From Oral Iron Supplementation—Gastrointestinal Side Effects and the Impact on the Gut Microbiota (2021) · cites this paper as [34]
In the citing paper
“The dynamics of the increase in hepcidin levels after oral iron therapy have suggested that alternate-day administration of iron salts is an alternative to daily refracted doses, with the former being a protocol that increases both efficacy and tolerability, at least in women with iron deficiency without or with mild anemia.116,118,119”
From Iron metabolism and iron disorders revisited in the hepcidin era (2020) · cites this paper as [116]
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“By changing iron dosing schedules to reflect the negative feedback mechanisms intrinsic to mammalian iron homeostasis, fractional iron uptake can be maximized. 185 , 186”
From The battle for iron in enteric infections (2020) · cites this paper as [185]
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Metadata
- Authors
- Stoffel, N. U., Zeder, C., Brittenham, G. M., Moretti, D., & Zimmermann, M. B.
- Affiliations
- ETH Zurich (CH)
- Columbia University (US)
- Corresponding author
- Stoffel, Nicole U.
- Venue
- Haematologica
- Published
- 2019-08-14
- Volume
- 105
- Issue
- 5
- Pages
- 1232-1239
- ISSN
- 0390-6078 (ISSN-L)
- 1592-8721
- PMC
- PMC7193469
- OpenAlex
- W2967031988
- Cited by
- 241
- References
- 30
- Citations by year
- 2026: 38 · 2025: 35 · 2024: 30 · 2023: 53 · 2022: 40 · 2021: 15 · 2020: 28 · 2019: 2
- FWCI
- 15.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Haematologica (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
- Keywords
- iron absorption, iron deficiency anemia, alternate-day dosing, oral iron supplementation, ferrous sulfate, hepcidin, iron status, erythrocyte iron incorporation, iron stable isotopes, women
- MeSH terms
- Female, Humans, Iron, Switzerland, Cross-Over Studies, Anemia, Iron-Deficiency, Dietary Supplements, Hepcidins
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